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Aim: Perinatal mortality can be used as a reference to assess health status in a country. In Indonesia, none of previous studies specifically discuss the incidence of prenatal mortality by region. The objective of this study was to analyze perinatal mortality difference by region of Indonesia. Study design: This study used a cross-sectional approach. Method: The sample in this study was 13,310 women of childbearing age obtained from the Indonesian Demographic Health Survey (IDHS) 2017. The perinatal mortality rate was calculated using data on stillbirths with a gestational duration of seven months or more and early neonatal deaths. Perinatal mortality was analyzed by region using a binary logistic regression statistical test to examine the relationship between perinatal mortality and its factors (socio-demographic factors, individual disease control factors, and maternal factors). Results: This study shows that the proportion of perinatal mortality in Indonesia is 1.5 % of total births. The highest proportion of perinatal mortality (2.5 %) was in the Papua region, while the lowest proportion (1.3 %) was in the Java region. The results of this study indicated that women in the Maluku Islands had a 1.82 times higher chance of perinatal mortality compared to the Java-Bali region. The causative variable associated with perinatal mortality in the Java-Bali and Papua regions was employment status. The causative variables associated with perinatal mortality in Kalimantan were the quality of antenatal care and delivery assistance. The causative variable associated with perinatal mortality in Nusa Tenggara and Papua was the location of delivery. The causative variable associated with perinatal mortality in Kalimantan, Maluku, and Papua was the mother's age. The causative variable associated with perinatal mortality in the Java-Bali region was parity. The causative variable associated with perinatal mortality in Sumatra was the type of delivery. Conclusion: This study show that there were disparities in the incidence of perinatal mortality between regions in Indonesia. The government needs to re-adjust the existing strategies to improve health status and focus on community empowerment for women to prevent perinatal mortality.

Background: India, as a nation is witnessing epidemiological transition, which is taking place across all the states at different level, over past couple of decades. Owing to the long natural history of non-communicable diseases (NCDs), early identification of these risk factors can aid in understanding the distribution and future development of cardiovascular diseases (CVDs). Also, studying the trend of these risk factors over time can help in prediction of burden of various CVDs in future. Thus, the present study aims at understanding the trend of various risk factors for CVDs across rural and urban India, and states. Methods: The present study was conducted using secondary data from the third, fourth and fifth round of the National Family Health Survey (NFHS) conducted in India. The surveys collected data for estimation of burden of the common modifiable risk factors of CVDs including tobacco and alcohol consumption overweight/obesity, raised blood pressure, and raised blood sugar. The analysis for the present study was done among interviewed males and females between 15 and 49 years. The weighted prevalence of these risk factors was computed and binary logistic regression was done to study the predictors for the same. Results: A declining trend of tobacco (29.2% in NFHS 3; 8.1%in NFHS 5) and alcohol consumption (14.2% in NFHS 3; 3.2%in NFHS 5) was observed from 2005 -06 to 2019–21. A rising trend of overall raised blood pressure (11.4% in NFHS 4; 12.2%in NFHS 5), raised blood sugar (6.2% in NFHS 4; 8.5%in NFHS 5), and overweight and obesity (11.4% in NFHS 3; 23.6%in NFHS 5) was observed from the three rounds of the survey. The odds of all the studied risk factors were significantly higher among older age across all the rounds of the survey. Except overweight/obesity, the odds of rest all studied risk factors was found to be higher among males compared to females. Also, higher odds of alcohol consumption, overweight/obesity, raised blood pressure, and raised blood sugar were found among the participants living in urban areas compared to rural areas, across all the rounds of the survey. Conclusion: The present highlights the rising burden of CVD risk factors, including overweight and obesity, raised blood pressure and raised blood sugar, and a declining trend of tobacco and alcohol consumption across the country. The study also highlights the need for in-depth assessment of predictors of these risk factors using longitudinal study designs.

In the Danish population, about one-in-ten adults have prediabetes, undiagnosed, poorly or potentially sub-regulated diabetes, for short DMRC. It is important to offer these citizens relevant healthcare intervention. We therefore built a model for prediction of prevalent DMRC.Data were derived from the Lolland-Falster Health Study undertaken in a rural-provincial area of Denmark with disadvantaged health. We included variables from public registers (age, sex, age, citizenship, marital status, socioeconomic status, residency status); from self-administered questionnaires (smoking status, alcohol use, education, self-rated health, dietary habits, physical activity); and from clinical examinations (body mass index (BMI), pulse rate, blood pressure, waist-to-hip ratio). Data were divided into training/testing datasets for development and testing of the prediction model.The study included 15,801 adults; of whom 1,575 with DMRC. Statistically significant variables in the final model included age, self-rated health, smoking status, BMI, waist-to-hip ratio, and pulse rate. In the testing dataset this model had an area under the curve (AUC) = 0.77 and a sensitivity of 50% corresponding to a specificity of 84%.In a health disadvantaged Danish population, presence of prediabetes, undiagnosed, or poorly or potentially sub-regulated diabetes could be predicted from age, self-rated health, smoking status, BMI, waist-to-hip ratio, and pulse rate. Age is known from the Danish personal identification number, self-rated health and smoking status can be obtained from simple questions, and BMI, waist-to-hip ratio, and pulse rate can be measured by any person in health care and potentially by the person him/her-self. Our model might therefore be useful as a screening tool.

Objectives: To evaluate the association of ultra-processed food (UPF) consumption with depression among Brazilian adults (≥18 years)., Study Design: Cross-sectional study., Methods: Data were obtained from a population-based survey conducted in 2023 (n = 21,690). UPF consumption was investigated using a questionnaire regarding the consumption on the previous day of 13 subgroups of UPF selected from those most consumed in Brazil according to a previous national survey (cutoff score ≥5 subgroups). The medical diagnosis of depression was self-reported. Logistic regression models were used to estimate the adjusted (by sex, age, education, presence of partner/spouse, and overweight) Odds Ratio (aOR) of UPF consumption according to the presence of depression. Analyses were conducted for the total population and stratified by sex., Results: Medical diagnosis of depression was reported by 12.3%. The prevalence of high UPF consumption (≥5 subgroups) was 17.7%, being higher in men (22.0%) and those with depression (19.3%). Depression increased the chance of presenting a high UPF consumption among the total population (aOR 1.35; CI 95% 1.08-1.68) and women (aOR 1.35; CI 95% 1.03-1.77), with no association among men., Conclusion: The presence of depression was associated with greater consumption of UPF among Brazilian adults, especially among the female population. Public health actions to reduce UPF consumption could benefit from targeting this population group., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Resumen: La utilización de cuestionarios como instrumentos de medición implica el uso de procesos lingüísticos. La variedad intralingüística del español conlleva diferentes modos de percibir, analizar y actuar en el mundo que deben considerarse al diseñar o adaptar cuestionarios. La armonización de los cuestionarios IA-PCAT (Primary Care Assessment Tools para Iberoamérica) difiere de los escenarios de adaptación transcultural descritos en la literatura porque intenta obtener un único producto en español adecuado para numerosas poblaciones meta a partir la armonización de cuestionarios provenientes de diversas poblaciones fuente hispanohablantes, por lo que requiere innovaciones en las categorías de análisis que se utilizan. El objetivo de este trabajo es proponer definiciones discriminantes de equivalencia conceptual, equivalencia práctica y aceptabilidad lingüística como categorías de análisis para la comprensión de cuestionarios, y ofrecer ejemplos de pruebas de comprensión realizadas mediante entrevistas cognitivas con profesionales y personas usuarias de servicios de salud. Abstract: The use of questionnaires as measuring tools involves the use of language. Spanish intralinguistic variation entails differences in the ways of perceiving the world, analyzing events and behaving, which must be taken into account when designing and adapting questionnaires. The IA-PCAT (Primary Care Assessment Tools for Iberomerica) harmonization process differs from the cross-cultural adaptation scenarios described in the scientific literature, since it intends to obtain a single Spanish product suitable for multiple target populations, that emanates from questionnaires previously adapted in several populations. Hence, this work requires the use of new analysis categories. The aim of this methodological note is to propose discriminant definitions of conceptual equivalence, practical equivalence and linguistic acceptability as analysis categories of the data collected during cognitive interviews to assess the questionnaires’ comprehension, carried out with health professionals and users of healthcare services.

Objectives: Dengue continues to remain a public health problem in many regions of the world. This study focuses on addressing the community level barriers and opportunities using a health education intervention model to aid in dengue control. Methods: In-depth interviews of frontline workers were conducted to understand potential barriers during surveillance. A house-to-house cross-sectional survey was conducted in November 2018 among the crowded urban Pratapnagar area followed by intervention in the form of health education using pamphlets and counselling. Results: The entomological indices were found to be above the critical levels in the hotspot area. 90% of the population had heard about dengue but only 51.4% had knowledge about fever as one of the symptoms of dengue. Overall knowledge among the community was good. But attitudes and practices were low and probably required more sustained health education intervention over prolonged period. The potential barriers for surveillance which were recognised during In-depth interviews were safety issues, lack of manpower and availability of dedicated vehicles, dearth of community participation and lack of inter and intra departmental coordination. Conclusion: The health administration needs to adopt robust surveillance and monitoring activities with inter-departmental coordination ensuring greater community participation focusing on behaviour change.

In Bangladesh, the telemedicine industry is one of the few industries able to flourish in the contemporary era of COVID-19. But to thrive, the industry must know the viewpoints of both consumers (those who are interested in availing the services of the industry) and non-consumers to overcome deficits. This should be done to maximize profits and give optimal utility to users so that the industry can be made sustainable in the long run. The main aim of this paper is to analyze the economic perception of both the telemedicine consumers and non-consumers of Bangladesh and the actions required to be taken to optimize them. A survey was developed with 18 questions divided into several parts relating to the health identity of the respondent, the respondents’ use of telemedicine, the analysis of the economic behaviors of the respondents with regards to telemedicine, and the consumer perception of the merits and demerits of telemedicine. The survey results show that about one-third has used some form of telemedicine during the COVID-19 pandemic. Among the telemedicine users, 48% used hospital-mandated telemedicine services whereas 41% used mobile telemedicine applications. The survey states that 75% were satisfied with the service they received. The average payment made by the respondent population was 532 Taka, and 62% of them thought that the amount they paid was justified. In conclusion, the results of this survey can be utilized in making economically viable telemedicine models that will give optimal utility to its consumers and help forecast the next stage of the industry for betterment in the health sector.

Objective: To estimate the prevalence of moderate and vigorous physical activity (MVPA), as defined by the World Health Organisation (WHO), and associated factors among teenagers from Barcelona in 2012. Methods: Cross-sectional survey to assess risk factors in a representative sample of secondary school students (aged 13–16 years, International Standard Classification of Education [ISCED] 2, n = 2,162; and 17–18 years, ISCED 3, n = 1016) in Barcelona. We estimated MVPA prevalence overall, and for each independent variable and each gender. Poisson regression models with robust variance were fit to examine the factors associated with high-level MVPA, and obtained prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: Only 13% of ISCED 2 and 10% of ISCED 3 students met the WHO physical activity recommendations. This percentage was lower among girls at both academic levels. MVPA was lower among ISCED 3 compared to ISCED 2 students, and among students with a lower socioeconomic status. Physical activity was associated with positive self-perception of the health status (e.g., positive self-perception of health status among ISCED 2 compared to ISCED 3 students: PR = 1.31 [95%CI: 1.22–1.41] and 1.61 [95%CI: 1.44–1.81] for boys and girls, respectively]. Conclusions: The percentage of teenagers who met WHO MVPA recommendations was low. Strategies are needed to increase MVPA levels, particularly in older girls, and students from low socioeconomic backgrounds.

Objective: To examine the effect of perceived discrimination and self-rated health among the immigrant population in the Basque Country, Spain, and determine whether this effect varies according to region of origin, age, sex and education. Methods: Descriptive cross-sectional study. The study population included immigrants aged 18 and older residing in the Basque Country. Data from the 2014 Foreign Immigrant Population Survey (n = 3,456) were used. Log-binomial regression was used to quantify the association between perceived discrimination and self-rated health before and after checking for the selected characteristics. Results: Almost 1 in 10 immigrant adults reports perceiving discrimination. In adjusted analyses, the immigrants perceiving discrimination were almost were 1.92 more likely to rate their health as poor (prevalence ratio: 1.92; 95% CI: 1.44–2.56) than those who did not report discrimination. This association did not vary according to region of origin, age, sex or educational level. Conclusions: Perceived discrimination shows a consistent relationship with perceived health. Moreover, this association did not depend on the region of origin, age, sex or educational level of immigrants. These results show the need for implementing inclusive policies to eliminate individual and institutional discrimination and reduce health inequalities between the immigrant and native populations.

Objective: To explore factors influencing perceptions and viewpoints on the responsibility for the presence of toxic substances in food, on enforcement of laws and regulations that control human exposure to toxic substances in food, and on the effectiveness of such regulations. Methods: An online survey was completed by 740 individuals from several parts of Spain (median age, 47 years; 67% were women; 70% had completed university studies). Results: Over 87% of respondents said that it was possible that throughout their lives they could have accumulated in their body toxic substances potentially dangerous to their health. The attribution of the responsibility for toxic substances in food to a larger number of social groups was more frequent among respondents who consulted information about the problem more often (odds ratio [OR]: 1.92), who correctly identified factors that increase the likelihood of toxic substances in food being harmful to human health (OR: 2.86), who better knew the health problems that may be caused by such substances (OR: 2.48), and who recognised more food groups that tend to have concentrations of toxic substances potentially harmful to health (OR: 2.92) (all p values

Objective: In the working population, poor mental health is a significant problem whose prevalence rates and associated factors could differ by gender, especially in a period of socioeconomic changes. The aims of this study were: a) to determine the prevalence of poor mental health in the working population of Spain in 2011; b) to identify the association of this prevalence with socioeconomic and work-related variables for men and women separately; c) to determine if the patterns differ by gender. Methods: A cross-sectional study was conducted with data from the National Health Survey of Spain (2011). Of the 21,007 participants in the survey, we selected 7396 whose employment status was described as “working” The General Health Questionnaire (GHQ-12) was used as a screening tool to detect poor mental health. Prevalences were calculated and bivariate and multivariate logistic regression models were fitted to verify the association between variables. Results: The prevalence of poor mental health was higher among women (19.9%) than men (13.9%), the overall prevalence being 16.8%. The variables associated with a higher prevalence were type of contract and work-related variables in men, and age and socioeconomic variables in women. Conclusions: This study shows that, in the working population of Spain, the prevalence of poor mental health and its related factors differ by gender. Poor mental health is mainly related to socioeconomic variables in women but is mostly associated with work-related variables in men.

Objective: To determine the prevalence of negative mood states in adolescents according to gender, to analyze variability among schools, and to evaluate the associated factors. Methods: A cross-sectional study with a cluster design was carried out. We administered the High-school students health survey to a sample of 9,340 students (aged 14-16 years) in the third and fourth year of Compulsory Secondary Education in Catalonia, Spain, during the 2005-6 academic year. The main outcome measure was evidence of a negative mood state. A multilevel logistic regression model stratified by gender was used to identify the factors associated with negative mood states and to determine variability among distinct schools. Results: Approximately 19% of adolescents reported evidence of a negative mood state, with a higher prevalence in girls (25%). The most significant factors associated with negative mood states were "use of tranquilizers" and "having eating disorders" in girls and "not exercising" and "poor self-perception of health status" in boys. In both genders, variability was found among schools in the prevalence of negative mood states (girls: variance = 0.078; p Objetivos: Determinar la prevalencia del estado de ánimo negativo entre alumnos adolescentes según sexo, analizar la variabilidad entre escuelas y evaluar los factores asociados. Métodos: Estudio transversal basado en un muestreo por conglomerados bietápico. Administramos una encuesta de salud a 9340 estudiantes de tercero y cuarto curso de Educación Secundaria Obligatoria de 14 a 16 años de edad, en Cataluña, durante el curso escolar 2005-06. La variable principal fue el estado de ánimo negativo. Se usó un modelo de regresión logística multinivel estratificado por sexo para identificar los factores asociados al estado de ánimo negativo y determinar la variabilidad entre las diferentes escuelas. Resultados: Aproximadamente el 19% de los adolescentes refirieron un estado de ánimo negativo, siendo más prevalente entre las chicas (25%). En ellas, los factores asociados significativamente con estados de ánimo negativo fueron «tomar tranquilizantes» y tener trastornos alimentarios, mientras que en los chicos fueron no realizar deporte y tener una mala percepción de su estado de salud. Hay variabilidad en la prevalencia del estado de ánimo negativo según las escuelas en ambos sexos (chicas: varianza = 0,078, p

Objetivos: Estimar la prevalencia de los síntomas depresivos en personas mayores de 64 años y analizar su asociación con variables sociodemográficas, marcadores de fragilidad y enfermedades incapacitantes. Métodos: Estudio descriptivo transversal mediante encuesta. La muestra estuvo constituida por 417 personas mayores de 64 años del área sanitaria de Guadalajara, seleccionados a partir de la tarjeta sanitaria. Para estimar los síntomas depresivos se utilizó el test de Yesavage, con un punto de corte de 6 o superior. El cuestionario contenía variables sociodemográficas, clínicas y escalas evaluativas sobre deterioro cognitivo, discapacidad y riesgo social. Los criterios de fragilidad estudiados fueron: edad mayor de 80 años, ser mujer, deterioro cognitivo, discapacidad, polifarmacia, comorbilidad y riesgo social. Resultados: La prevalencia de síntomas depresivos fue del 19,7% (intervalo de confianza &(IC&) del 95%, 15,9-23,4) y tenían diagnóstico de depresión clínica el 5% (IC del 95%, 2,3-7,7). Los síntomas eran más frecuentes en el medio rural (p < 0,05), aumentaban con la edad (p de tendencia lineal < 0,001) y estaban asociados con el riesgo social (p < 0,001), la comorbilidad (p < 0,001), el deterioro cognitivo (p < 0,01) y la discapacidad (p < 0,05). En el análisis multivariante a partir de modelos de regresión logística, sólo la comorbilidad (odds ratio &(OR&) = 2,38; IC del 95%, 1,35-4,20) y el riesgo social (OR = 2,69; IC del 95%, 1,50-4,83) mostraron una asociación estadísticamente significativa. Conclusiones: La prevalencia de síntomas depresivos es muy elevada en las personas mayores de 64 años, 4 veces superior a la frecuencia de depresión clínica, y se asocia con el riesgo social y la comorbilidad.Objectives: To estimate the prevalence of depressive symptoms in people older than 64 and to analyze their association with sociodemographic factors, frailty markers, and disabling diseases. Methods: A survey-based, cross-sectional descriptive study was carried out. The sample was composed of 417 elderly people living in Guadalajara (Spain), selected on the basis of health cards. Depressive symptoms were assessed using Yesavage's test (cut-off: 6 or more items). The questionnaire contained sociodemographic and clinical items and evaluation scales for cognitive impairment, disability, and social risk. The frailty markers studied were age over 80 years old, female sex, cognitive impairment, disability, polypharmacy, comorbidity, and social risk. Results: The prevalence of depressive symptoms was 19.7% (95% CI, 15.9-23.4) and clinical depression was diagnosed in 5% (95% CI, 2.3-7.7). Depressive symptoms were more frequent in elderly individuals living in rural environments than in those living in urban areas (p < 0.05). These symptoms increased with age (p linear trend < 0.001) and were associated with social risk (p < 0.001), comorbidity (p < 0.001), cognitive impairment (p < 0.01), and disability (p < 0.05). When a multivariate statistical analysis was applied using logistic regression models, only comorbidity (odds ratio &(OR&) = 2.38; 95% CI, 1.35-4.20) and social risk (OR = 2.69; 95% CI, 1.50-4.83) were significantly associated. Conclusions: The prevalence of depressive symptoms is very high in the elderly, four times higher than a diagnosis of clinical depression. Social risk and comorbidity are strongly associated with depressive symptoms.

Objetivos: El objetivo de este trabajo es evaluar los cambios en las coberturas antigripales en España y en cada comunidad autónoma entre 2001 y 2003 y comparar las coberturas vacunales estimadas por las Encuestas Nacionales de Salud (ENS) con otras fuentes oficiales de información. Métodos: Se han analizado un total de 42.722 registros de las ENS de los años 2001 (n = 21.072) y 2003 (n = 21.650). Todos ellos corresponden a adultos españoles mayores de 15 años no institucionalizados. Ambas encuestas son representativas en el ámbito de las comunidades autónomas. Resultados: Para el total de la muestra se estima una cobertura vacunal en 2001 del 19,3% (intervalo de confianza (IC) del 95%, 18,8-19,8) y del 22,1% (IC del 95%, 21,4-22,8) en 2003. En el modelo de regresión logística, ajustado por edad, género y enfermedad crónica asociada, se observan mejoras significativas en las coberturas del grupo de mayores de 64 años (odds ratio = 1,26; IC del 95%, 1,14-1,40) para el total de España y en 6 comunidades autónomas entre 2001 y 2003. En el grupo de menores de 65 años con una enfermedad crónica asociada, se observó un aumento significativo de las coberturas en el global de España y en 3 comunidades autónomas. Conclusiones: Entre 2001 y 2003 se observaron mejorías en las coberturas de vacunación en los grupos de riesgo estudiados en España y en varias comunidades autónomas. La información sobre las coberturas vacunales aportada por las ENS es parecida a la encontrada en encuestas de salud de las comunidades autónomas y en el Ministerio de Sanidad y Consumo.Objectives: To evaluate changes in influenza vaccination coverage in Spain by autonomous communities between 2001 and 2003 and to compare the influenza vaccination coverage obtained in Spanish National Health Surveys (NHS) with other official sources. Methods: A total of 42,722 cases from the NHS for 2001 (n = 21,072) and 2003 (n = 21,650) were analyzed. All the cases corresponded to adults aged more than 15 years old. Both surveys are representative of the autonomous communities. Results: For the entire sample, vaccine coverages of 19.3% (95% CI, 18.8-19.8) and 22.1% (95% CI, 21.4-22.8) were estimated in 2001 and 2003 respectively. In the logit regression model adjusted by age, sex and associated chronic diseases, significant improvements were found in coverage in individuals aged more than 64 years (odds ratio = 1.26; 95% CI, 1.14-1.40) for Spain as a whole and for 6 autonomous communities between 2001 and 2003. For the group aged less than 65 years with associated chronic diseases, a significant improvement in coverage was found for Spain as a whole and for 3 autonomous communities. Conclusions: Between 2001 and 2003, influenza vaccination coverage in the risk groups studied significantly improved in Spain and in several autonomous communities. The information on influenza vaccination coverage obtained in the Spanish National Health Surveys was similar to that found in the Autonomous Communities Health Surveys and in the Ministry of Health and Consumer Affairs.

Objetivos: Estimar los pesos de calidad de vida para España, para los años 1987, 1993 y 2001, a partir del estado de salud autopercibido declarado en la Encuesta Nacional de Salud. Material y métodos: Los pesos de calidad se han estimado mediante un modelo probit ordenado en el que el estado de salud autopercibido se relacionaba con la presencia de enfermedades crónicas, características demográficas y un error aleatorio, y normalizado a partir de una transformación de los estimadores obtenidos en el modelo. Resultados: La calidad de vida asociada con las enfermedades crónicas difiere según cuáles sean éstas. Las dolencias, las limitaciones y las enfermedades en los últimos 12 meses reducen más la calidad de vida que las enfermedades crónicas. La calidad de vida disminuye a medida que aumenta la edad y se incrementa a medida que aumenta el nivel de estudios. Para una misma enfermedad, y tras ajustar por edad, sexo y nivel de estudios, los pesos de calidad de vida en los años 1993 y 2001 son mayores que en el año 1987. Conclusiones: La metodología propuesta permite calcular los pesos de calidad de vida a partir de los datos de las encuestas de salud, con una aplicación directa en la evaluación económica, el análisis de las desigualdades socioeconómicas en el estado de salud de las poblaciones y el cálculo del capital de salud.Objectives: To estimate quality of life weights in Spain for 1987, 1993 and 2001, based on self-assessed health status reported in the National Health Survey. Material and methods: Quality of life weights were estimated using an ordered probit model. In this model, self-assessed health status was related to the presence of chronic diseases, demographic characteristics, and a random error. Quality of life weights were derived by normalizing the regressors obtained. Results: Quality of life values related to chronic diseases varied depending on the diseases. Pain, limitations, and diseases in the previous 12 months had a greater negative impact on quality of life than did chronic diseases. Quality of life decreased as age increased, and increased as educational level increased. For the same disease and adjusted for age, sex, and educational level, quality of life weights were greater for 1993 and 2001 than for 1987. Conclusions: The proposed methodology allows quality of life weights to be calculated from health survey data, which has direct application in economic assessment, analysis of socioeconomic health inequalities, and health capital estimation.

Para identificar la posible existencia de sesgos de género en el lenguaje del cuestionario de Adultos y del cuestionario de Hogar de la Encuesta Nacional de Salud (ENS) de 2003, se analiza su lenguaje/estilo respecto a generalizaciones imprecisas, desigualdad de trato por uso de términos que reflejan estereotipos sociales y ocultan desigualdad de roles sociales y discordancia gramatical de género. Se evidencia la presencia de sesgos lingüísticos en su mayoría de tipo léxico, pues ambos cuestionarios utilizan el masculino singular refiriéndose al conjunto de informantes (p. ej., cuidador, empleador, trabajador, médico, entrevistado o entrevistador). También se observan estereotipos de género cuando al utilizar el término «cuidador» se hace referencia a mujeres para este rol, o se ejemplifica la profesión con ocupaciones clásicamente masculinas. Igualmente, cuando se juntan parentescos masculinos/femeninos (p. ej., hermano/a) en la misma categoría se ocultan desigualdades de género respecto a roles sociales. Se concluye que las mujeres están menos presentes formalmente que los hombres en la ENS de 2003. Esta experiencia puede contribuir a observar y eliminar sesgos de género del lenguaje en otros cuestionarios.To identify possible gender bias in the language of the adults' and children's questionnaires of the Spanish National Health Survey, 2003, its style and language was analyzed for inaccurate generalizations, inequalities due to the use of terms that reflect social stereotypes and hide unequal social roles, and grammatical gender disagreement. Both questionnaires show language bias, mainly lexical, as they use masculine singular nouns to refer to all individuals (for example, carer, employer, worker, doctor, interviewer, interviewee). Gender stereotypes are reinforced by the use of the term «carer», referring to women, and by examples of jobs traditionally done by men. Equally, specific sex denomination for relatives in the same category such as brother/sister is lacking, despite the distinct social roles played by women and men. In conclusion, women are less visible than men in the Spanish National Health Survey, 2003. This study could contribute to the identification and elimination of gender bias in the language of other questionnaires.

Objetivos: Analizar la variabilidad en el número de cigarrillos fumados por persona y día en España según la fuente de información (encuestas de salud y datos de ventas). Métodos: Se comparó el consumo de cigarrillos diarios por persona y día (población >16 años de edad) obtenido de las encuestas nacionales de salud y de los datos sobre ventas de tabaco del Comisionado para el Mercado de Tabacos entre 1993 y 2009. Resultados: El consumo de cigarrillos diarios por persona y día disminuyó entre 1993 y 2009. En todo el periodo, el número de cigarrillos fumados por persona y día según las ventas excedieron a los derivados de las encuestas de salud (hasta un 46,9%). Conclusión: La diferencia entre el número de cigarrillos fumados obtenidos entre las ventas y las encuestas de salud ha aumentado en los últimos años.Objectives: To assess the variability in the number of cigarettes smoked per person per day in Spain according to the information source (health surveys versus legal sales). Methods: We compared cigarette consumption per person per day (population aged >16 years) obtained from the national health surveys in Spain and the official data on legal tobacco sales between 1993 and 2009. Results: Cigarette consumption per person per day decreased between 1993 and 2009. Over the entire period, the number of cigarettes smoked per person per day according to legal sales exceeded that reported by national health surveys (up to 46.9%). Conclusion: The difference in data on the number of cigarettes smoked between national health surveys and legal sales has increased in the last few years in Spain.

Objetivos: Describir la red social, el apoyo social y la salud mental en la población no institucionalizada de 65 o más años de Barcelona, y analizar la relación entre salud mental, red social y apoyo social según el sexo y el grupo de edad. Métodos: Estudio transversal. La muestra esta formada por personas de 65 o más años entrevistadas en la Encuesta de Salud de Barcelona 2000 (389 varones y 609 mujeres). La salud mental se valoró mediante el General Health Questionnaire-12 (GHQ-12). Se realizó un análisis descriptivo, así como un análisis bivariado y multivariado (regresión logística), para evaluar la relación entre la presencia de trastornos mentales y las variables de red y apoyo social, ajustado por el estado de salud percibido y las discapacidades. Resultados: Según el GHQ-12, el 21,8% de las mujeres y el 9,4% de los varones sufren trastornos mentales. El análisis multivariado en los varones pone de manifiesto que no ver a los amigos regularmente está asociado con sufrir trastornos mentales en el grupo ≥ 75 años (odds ratio [OR] = 5,76; intervalo de confianza [IC] del 95%, 1,77-18,7); el menor apoyo social, según el Perfil de Duke, y la falta de apoyo emocional están relacionados en los 2 grupos de edad analizados (65-74 y ≥ 75 años). En las mujeres de 75 o más años, el no ver a los amigos regularmente también se asocia con la presencia de trastornos mentales, y el menor apoyo social según el Perfil de Duke se asocia en ambos grupos de edad analizados. Conclusiones: Existe una relación entre la red y el apoyo social y la salud mental en la población anciana de Barcelona. Las políticas de integración social podrían tener efectos beneficiosos para la salud mental de esta población.Objectives: To describe social networks, social support and mental health among non-institutionalized individuals aged 65 years or older of Barcelona (Spain), and to analyze the relationship between mental health and social network and social support in this population by gender and age subgroup. Methods: A cross-sectional study was performed. The sample consisted of individuals aged 65 years or more (389 men and 609 women) who took part in the Household Health Survey of Barcelona in 2000. Mental health was screened through the General Health Questionnaire-12 (GHQ-12). A descriptive analysis, as well as bivariate and multivariate analyses (logistic regression), were performed to analyze the association between mental disorders and social network and social support, adjusted by perceived health status and disabilities. Results: According to the GHQ-12, 21.8% of the women and 9.4% of the men had some mental disorder. Multivariate analysis showed that among men mental disorders were associated with not seeing friends regularly in the subgroup aged 75 years or more (OR = 5.76; 95% CI = 1.77-18.7) and with low social support according to Duke's profile and lack of emotional support in both age groups (65-74 years and 75 years or more). For women, mental disorders were associated with not seeing friends regularly in the subgroup aged 75 years or more and with low social support according to the Duke's profile in both age groups. Conclusions: Mental health in the elderly population in Barcelona is associated with social network and support. Policies to promote social support could improve mental health in this population.

This report gives a comprehensive explanation of the multivariate technique called correspondence analysis, applied in the context of a large survey of a nation's state of health, in this case the Spanish National Health Survey. It is first shown how correspondence analysis can be used to interpret a simple cross-tabulation by visualizing the table in the form of a map of points representing the rows and columns of the table. Combinations of variables can also be interpreted by coding the data in the appropriate way. The technique can also be used to deduce optimal scale values for the levels of a categorical variable, thus giving quantitative meaning to the categories. Multiple correspondence analysis can analyze several categorical variables simultaneously, and is analogous to factor analysis of continuous variables. Other uses of correspondence analysis are illustrated using different variables of the same Spanish database: for example, exploring patterns of missing data and visualizing trends across surveys from consecutive years.Este artículo desarrolla una amplia explicación de una técnica de análisis multivariada denominada análisis de correspondencias, aplicándola a datos de una encuesta nacional de salud, en este caso la Encuesta Nacional de Salud española (ENS). Primero se indica cómo puede utilizarse el análisis de correspondencias para interpretar una tabla de contingencia visualizándola en forma de un gráfico de puntos que representan las filas y columnas de la tabla. También pueden ser interpretadas diferentes combinaciones de las variables codificando los datos de la manera apropiada. Esta técnica puede emplearse también para obtener valores óptimos de escala para los niveles de una variable categórica, dándole de este modo un sentido cuantitativo a este tipo de variables. El análisis de correspondencias múltiple puede analizar varias variables categóricas simultáneamente, y es análogo al análisis de factores de las variables continuas. Otras aplicaciones del análisis de correspondencias se ilustran usando diferentes variables de la ENS; por ejemplo, para analizar pautas en los datos perdidos y visualizando tendencias entre encuestas de años consecutivos.

This report gives a comprehensive explanation of the multivariate technique called correspondence analysis, applied in the context of a large survey of a nation's state of health, in this case the Spanish National Health Survey. It is first shown how correspondence analysis can be used to interpret a simple cross-tabulation by visualizing the table in the form of a map of points representing the rows and columns of the table. Combinations of variables can also be interpreted by coding the data in the appropriate way. The technique can also be used to deduce optimal scale values for the levels of a categorical variable, thus giving quantitative meaning to the categories. Multiple correspondence analysis can analyze several categorical variables simultaneously, and is analogous to factor analysis of continuous variables. Other uses of correspondence analysis are illustrated using different variables of the same Spanish database: for example, exploring patterns of missing data and visualizing trends across surveys from consecutive years.

Background: Pre-registration midwifery students in Australia undertake a minimum of ten continuity of care experiences with childbearing women. However, women are rarely asked to formally evaluate this care by students., Aim: To evaluate data from a routine, web-based survey of women about having a midwifery student provide a continuity of care experience., Methods: All women (n=886) recruited by a midwifery student for a continuity of care experience during a 12 month period received an email inviting them to complete an online survey. The survey included personal details, experiences of care, and two scales on Respect and Satisfaction., Results: A response rate of 57% (n=501) was achieved. On average students attended six antenatal visits (mean=5.83) and had six postnatal contacts with women. Most students attended labour and birth (92.6% n=464). Most women rated overall satisfaction with care by their student as 'better than they had hoped'. Positive correlations were found between number of antenatal visits and postnatal contact with students on both levels of satisfaction and respect felt by women. Women felt more satisfied when their midwifery student attended labour and birth., Conclusions: The online survey was feasible and provided valid and reliable feedback from women about their student during a continuity of care experience. Women valued having an ongoing relationship with a student during pregnancy, labour and birth, and postpartum. Pre-registration midwifery education programs should continue to privilege relationship-based care and national standards should support the effective integration of continuity of care experiences., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: Diabetes mellitus is a disease associated with many complications leading to premature death. The aim of this study was to estimate prevalence of type 2 diabetes (T2D), and the proportion of the population unaware of the condition, in association with modifiable risk factors., Study Design: Data from the Hellenic National Nutrition and Health Survey were used (n = 3773 adults, 40.8% men) and were obtained by trained personnel., Methods: Diabetes mellitus disease status was categorized as per the International Classification of Diseases codes (10th version). A subsample from the two main metropolitan areas was used to assess T2D and impaired fasting glucose (IFG) (n = 990; 38.2% men) from plasma analysis., Results: The prevalence of T2D in the population was 5.2% in total, reaching 13.7% in adults aged >60 years (no sex differences). IFG was observed in 27.3% of adults in the two metropolitan areas, and 40% were unaware of having T2D in this subsample. The likelihood of having T2D significantly increased with age and body weight, whereas it decreased with higher educational level and physical activity (P for all <0.001)., Conclusion: The high T2D prevalence in adults, especially among the older age-groups, suggests a major public health problem in Greece., (Copyright © 2020. Published by Elsevier Ltd.)